1761. Effect of Carbapenem-Resistant Enterobacteriaceae (CRE) Surveillance Case Definition Change on CRE Epidemiology - Selected U.S. Sites, 2015-2016
Session: Oral Abstract Session: Healthcare Epidemiology: You Can try this at Home - Innovative Epi Abstracts
Saturday, October 6, 2018: 10:30 AM
Room: S 157

Carbapenem-resistant Enterobacteriacae (CRE) are an urgent US public health threat. CDC reported CRE incidence to be 2.93 / 100,000 population in 2012-2013 in selected sites but changed the CRE surveillance case definition in 2016 to improve sensitivity for detecting carbapenemase-producing (CP) CRE. We describe CRE epidemiology before and after the change.


Eight CDC Emerging Infections Program sites (CO, GA, MD, MN, NM, NY, OR, TN) conducted active, population-based CRE surveillance in selected counties. A case was defined as having an isolate of E. coli, Enterobacter, or Klebsiella meeting a susceptibility phenotype (Figure) at a clinical laboratory from urine or a normally sterile body site in a surveillance area resident in a 30-day period. We collected data from medical records and defined cases as community-associated (CA) if no healthcare risk factors were documented. A convenience sample of isolates were tested for carbapenemase genes at CDC by real-time PCR. We calculated incidence rates (per 100,000 population) by using U.S. Census data. Case epidemiology and the proportion of CP-CRE isolates in 2015 vs 2016 were compared.


In total 442 incident CRE cases were reported in 2015, and 1,149 cases in 2016. Most isolates were cultured from urine: 87% in 2015, and 92% in 2016 (p<.001). The crude overall pooled mean incidence in 2015 was 2.9 (range by site: 0.45-7.19) and in 2016 was 7.48 (range: 3.13-15.95). The most common CRE genus was Klebsiella (51%) in 2015, and in 2016 was Enterobacter (41%, p<.001). Of the subset of CRE isolates tested at CDC, 109/227 (48%) were CP-CRE in 2015, and 109/551 (20%) were CP-CRE in 2016. In 2015, 52/442 (12%) of cases were CA CRE, and in 2016, 267/1149 (23%) were CA CRE (p<.001). In 2016, 3/111 (2.7%) of CA CRE isolates tested were CP-CRE.


A large increase in reported CRE incidence was observed after the change in the case definition. The new case definition includes a substantially larger number of Enterobacter cases. A decrease in CP-CRE prevalence appears to be driven by an increase in non-CP-CRE cases. Although CP-CRE in the community still appear to be rare, a substantial proportion of phenotypic CRE appear to be CA, and CDC is undertaking efforts to further investigate CA CRE, including CP-CRE.

Nadezhda Duffy, MD, MPH1, Sandra N. Bulens, MPH1, Hannah Reses, MPH1, Maria S. Karlsson, PhD1, Uzma Ansari, MS1, Wendy Bamberg, MD2, Sarah J. Janelle, MPH, CIC2, Jesse T. Jacob, MD3, Chris Bower, MPH4, Lucy E. Wilson, MD5, Elisabeth Vaeth, MPH6, Ruth Lynfield, MD, FIDSA7, Medora Witwer, MPH7, Erin C. Phipps, DVM, MPH8, Ghinwa Dumyati, MD, FSHEA9, Rebecca Pierce, PhD, MS, BSN10, P. Maureen Cassidy, MPH11, Marion A. Kainer, MBBS, MPH12, Daniel Muleta, MD, MPH13 and Isaac See, MD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Colorado Department of Public Health and Environment, Denver, CO, (3)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (4)Georgia Emerging Infections Program, Decatur, GA, (5)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (6)Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, MD, (7)Minnesota Department of Health, St. Paul, MN, (8)New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, (9)NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, (10)Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (11)Oregon Health Authority, Portland, OR, (12)Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, TN, (13)Tennessee Department of Health, Nashville, TN


N. Duffy, None

S. N. Bulens, None

H. Reses, None

M. S. Karlsson, None

U. Ansari, None

W. Bamberg, None

S. J. Janelle, None

J. T. Jacob, None

C. Bower, None

L. E. Wilson, None

E. Vaeth, None

R. Lynfield, None

M. Witwer, None

E. C. Phipps, None

G. Dumyati, Seres: Scientific Advisor , Consulting fee .

R. Pierce, None

P. M. Cassidy, None

M. A. Kainer, None

D. Muleta, None

I. See, None

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